Roofers Public Liability Insurance Quote Form

For UK Customers Only

Please insert your details here and one of our commercial advisers will contact you shortly with a roofers liability insurance quote.

This form is designed for quotes for Roofers and Roofing Contractors Public Liability Insurance quotes only. Cover can be extended to include employers liability insurance if you have employees or use labour only sub-contractors.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Personal/Company Details

Proposer's Full Name(s):(enter sole trader's name or all partner's names if a partnership)

Contact Name:(if different to proposer's name)

Limited Company Name:(if operating as a limited company)

Trading Name:(if different to the above)

Trading Status:

Business Address:

Postcode:

Daytime Telephone Number:

Mobile Telephone Number:

*E-Mail Address:

*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.

General Information

Have you, or any other partner or directorever been convicted of or charged (but not yet tried)with any criminal offences other than a motoring offence?

Yes No

If yes, please provide details:(e.g. type of conviction(s), date(s) of conviction(s),details of any fines and/or length of custodial sentence(s))

Has any insurer ever refused renewal,declined/cancelled cover or imposed any special terms?

Description of work undertaken:(Please describe as fully as possible including apercentage split between each activity whereyou carry out more than one activity)

Does any of your work involve roof / wall cladding?

Yes No

If yes, please confirm percentage cladding work:(e.g. 10%)

Do you only use fire retardant cladding?

Yes No

Type of premises worked on

Please state the percentage of work carried out at the following locations:

Private dwelling houses and flats?

%

Commercial buildings (e.g. shops, offices, etc.)?

%

Industrial buildings (e.g. industrial units, factories, etc.)?

%

All other premises (state below if applicable)?

%

Total:

100%

Is work carried out at any hazardous locations?(Hazardous locations can include, but are not limited to; railways, motorways,bridges, viaducts, nuclear installations, refineries, airports, quarries, mines,ships, docks, piers, towers and offshore installations.)

Yes No

If yes, please state type of location(s) and thepercentage of work spent at the location(s):

What percentage of your work involvesworking with hazardous materials (e.g. 10%)?

Trade Associations

Is your company a member of theNFRC or any other relevant trade association?

Yes No

If yes, please provide details of trade association(s):

Health & Safety

Do you have awritten Health & Safety policy in force?

Yes No

Do you carry out a full Health & Safety RiskAssessment at the contract site before commencing work?

Yes No

Are written Method Statements prepared for each job?

Yes No

Is Health & Safety training givento employees and is the training recorded?

Yes No

Do you supply and enforce use ofPersonal Protective Equipment where required?

Yes No

Trading Experience

How many years has your business been trading?

year(s)

Number of years previous experience in this trade:(A minimum of 3 years previous experience is required if you have 0 years trading)

year(s)

Claims History

Have you, or any other partner or director suffered any loss or had any claims made against you in the last 5 years?

Yes No

If yes, please provide details:

Details Of Liability Cover Required

Public Liability

Public Liability limit of indemnity required:

Manual Principals

Non-Manual /Clerical Principals

Number of proprietors/partners/company directors:

No.

No.

Annual wages of proprietors/partners/Co. directors:

Annual payments to Bona Fide Sub-Contractors:(BFSC's are sub-contractors who supply their ownmaterials on site and hold their own insurance)

Estimated Turnover

Estimated turnover for the next 12 months:(Please be as accurate as possible, as an overestimation will increase the premium to be quoted)

In respect of the total turnover above, please confirm the percentage split in respect of the following:

(i) Slating and tiling:

%

(ii) Mastic asphalt, flat and felt roofing contracts:

%

(iii) Industrial sheeting and cladding contracts:

%

(iv) All other roofing contracts:

%

(v) All other (non-roofing) turnover (if applicable):

%

Total:

100%

Employers Liability(Compulsory by Law if you employ direct employees or labour only sub-contractors)

Is Employers Liability required?(£10M standard limit of indemnity)

Manual Workers

Non-Manual /Clerical Workers

Total no. of employees/labour only sub-contractors:(Do not include proprietors, partners and directors)

No.

No.

Annual wages of employees working at own premises:

Annual wages of drivers/yardsmen:

Annual Wages of Employees Working Away on Site

Annual wages of employees working away at ground level:

Annual wages of employees working away and at height:

Annual payments to Labour Only Sub-Contractors:(LOSC's are sub-contractors who supply only labour and not materials)

Annual wages of supervisors working at ground level:

Do all your relevant employees andLabour Only Sub Contractors have current CSCS cards?

Yes No

Employers' Reference Number (optional)

Employers' Reference Number (ERN) (if available):

(e.g. 123/AB12345)

Additional Covers

Legal Expenses Cover (Optional)

Is Business Legal Expenses cover required?(£100,000 standard limit of indemnity)

Yes No

Legal Expenses Limit of Indemnity:

Has the business and/or its directors beeninvolved in any legal dispute, tax investigationor any other court or tribunal action in the last 5 years?

Yes No

Please provide details of the dispute including dates:

Directors & Officers Cover (Optional)

Is Directors and Officers cover required?

Yes No

Please confirm the limit of indemnity required:

Additional Information

Details of any additional information youwish to disclose or any other cover required:

You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.

Details Of Current / Previous Policies

Cover Start Date / Renewal Date:

Current Annual Premium / Best Quote:

This may help us to get you a better quote

Name of Current / Previous Insurer:

e.g. ECIC, IIGL, Kerry London (KL), Pen Underwriting, etc.

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the Request Roofers Liability Quotation button and we will contact you shortly with a quotation.